Palliative care bodies sound the alarm on opioid supply crisis

Palliative care groups have raised the alarm over the discontinuation of a number of routinely used opioid-based pain medications, labelling the situation ‘a looming crisis’.
 
The growing list of discontinued medications are relied on to effectively manage crippling pain and breathing difficulties during end-of-life care and cancer treatment.
 
Ordine (morphine) oral liquid, considered an essential medicine, is the most recent drug to be discontinued and it is expected that supply will be completely depleted across Australia by the end of March.
 
Other medicines that will be discontinued over the coming months include Oxynorm (oxycodone) capsules, MS Mono (morphine) capsules and Sevredol (morphine) tablets.
 
Chair of RACGP Specific Interests Cancer and Palliative Care Associate Professor Joel Rhee told newsGP that the supply issues will add a layer of risk when providing palliative care.
 
‘This is a serious situation,’ he said.
 
‘While GPs can manage the discontinuations by substituting with another opiate, it introduces the risk of patient and/or carer confusion and dosing errors, especially if an unfamiliar medication is prescribed.’
 
Associate Professor Rhee recommends that GPs use opioid conversion calculators to minimise the risk of harm and encourages prescribers to seek advice when needed and carefully counsel their patients when transitioning to new medications.
 
Similar concerns were raised by the CEO of Palliative Care Australia, Ms Camilla Rowland.
 
‘This is a serious risk for all Australians requiring management of serious pain,’ Ms Rowland said.
 
‘These discontinuations and shortages threaten the safe delivery of quality care – especially for vulnerable patients like young children and those with a cancer diagnosis – not to mention the tremendous anxiety these announcements continue to cause clinicians, patients, and carers.’
 
It is estimated that hundreds of thousands of scripts for the discontinued medications are dispensed annually, and there is currently no long-term solution to shortages.
 
The situation has been designated a high priority by the Therapeutic Goods Administration, which has advised that pharmacies can import alternatives to Ordine and other discontinued opioid medicines. However, the cost of these medicines may vary and there are safety concerns as not all products are labelled in English.
 
Peak palliative care bodies, including Palliative Care Australia and the Society of Hospital Pharmacists of Australia (SHPA), have joined forces to campaign for change and have called for Federal Health and Aged Care Minister Mark Butler to take immediate action.
 
A list of health policy changes have been put forward, including an extension of the minimum notice period for discontinuation of palliative care medications being extended from six to 12 months, alongside better communication and a review of the TGA registration and PBS application process for medicines of critical need.
 
Peak bodies have also proposed that pharmaceutical companies manufacture opioid pain medications locally to meet demands, with Australia already considered one of largest global producers of raw materials to produce opioid medications.
 
‘I would welcome government interest and intervention, to make sure that there is more stability in the supply of opiate and other palliative care medications,’ Associate Professor Rhee said.
 
Meanwhile, SHPA President Tom Simpson says that the temporary measures currently in place to assist with supply issues fall short of a long-term, sustainable solution.
 
‘The cost of alternatives sourced from overseas to replace locally registered medicines is almost always higher, and this can be a barrier for many people and health services,’ Mr Simpson said.
 
‘There is no guarantee that the alternative product will be subsidised by the PBS either, which can easily quadruple the cost of the discontinued Australian-registered product.
 
‘There have also been problems with labels written in foreign languages and the size of the deliveries we are receiving can make these alternatives hard to administer safely and cost effectively.’
 
The TGA recommends that prescribers who switch patients to alternative opioid medications may need to refer to palliative care or pain specialists if they are unfamiliar with the alternative medicines available to avoid dosing error and patient harm.
 
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end-of-life care medication shortages palliative care